Colonic stenting in the management of acute left-sided malignant colonic obstruction is oncologically safe?

Abstract

The management of patients presenting with acute large bowel obstructioncaused by left sided colorectal cancer is still debated.Colonic stenting (CS) seems to be a good therapeutical option toemergency surgery: it is able to convert an urgent situation in anelective one. Lately conflicting results were published about thistechnique used as bridge to surgery in comparison with the emergencysurgery in terms of oncologic safety and recurrence rate.Actually self expandable metallic stents (SEMS) are not “allowed”to treat potentially curable patients. Data reported in literatureshow that colonic stenting improves primary anastomosis ratewith a low stoma creation in comparison with emergency surgery,enhancing patients’ quality of life, without differences in terms ofmortality and morbidity rate. According to available data, at oneyear follow up time, the recurrence rate is higher in patients treatedwith stent, with no statistical difference in terms of disease freesurvival and overall survival.Endoscopist’s experience, type of colic obstruction (partial or total),type of stent, insertion technique and timing of surgery arefundamental to reach CS technical and clinical success.Oncologic (un)-safety of colonic stenting has to be still investigatedand confirmed by medium and long term follow up of largeprospective studies and randomized controlled trials comparingSEMS and ES.